van Spronsen Margot F, Ossenkoppele Gert J, Westers Theresia M, van de Loosdrecht Arjan A
Department of Hematology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
Department of Hematology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
Eur J Cancer. 2016 Mar;56:10-20. doi: 10.1016/j.ejca.2015.12.004. Epub 2016 Jan 19.
Numerous morphological classification models have been developed to organise the heterogeneous spectrum of myelodysplastic syndromes (MDS). While the 2008 update of the World Health Organisation (WHO) is the current standard, the publication of the revised International Prognostic Scoring System (IPSS-R) has illustrated the need for supplemental prognostic information. The aim of this study was to investigate whether morphological classification models for MDS - of both the French-American-British (FAB) group and WHO - provide reliable criteria for their classification into homogeneous and clinically relevant categories with prognostic relevance beyond the IPSS-R. We reclassified 238 MDS patients using each of the FAB, WHO 2001 and WHO 2008 criteria and studied classification categories in terms of clinical, haematological and cytogenetic features. Subsequently, we calculated prognostic scores using the IPSS-R and investigated whether the morphological classification models had significantly prognostic value in patients stratified by the IPSS-R and vice versa. By adopting the FAB, WHO 2001 and WHO 2008 classifications, MDS patients were organised into homogeneous categories with intrinsic prognostic information. However, whereas the morphological classification models showed no prognostic value beyond the IPSS-R, the IPSS-R had significant prognostic value beyond the FAB, WHO 2001 and WHO 2008 classifications. Even though morphological classification models for MDS might be clinically relevant from a prognostic point of view, their relevance in terms of risk stratification is evidently limited in light of the IPSS-R. Therefore, we suggest to stop the use of morphological classification models for MDS for risk stratification in routine clinical practice.
为了梳理骨髓增生异常综合征(MDS)的异质性谱,已经开发了许多形态学分类模型。虽然世界卫生组织(WHO)2008年更新版是当前的标准,但修订后的国际预后评分系统(IPSS-R)的发布表明需要补充预后信息。本研究的目的是调查MDS的形态学分类模型——法国-美国-英国(FAB)组和WHO的模型——是否能为将其分类为具有超出IPSS-R预后相关性的同质且临床相关类别提供可靠标准。我们使用FAB、WHO 2001和WHO 2008标准中的每一种对238例MDS患者进行重新分类,并从临床、血液学和细胞遗传学特征方面研究分类类别。随后,我们使用IPSS-R计算预后评分,并调查形态学分类模型在按IPSS-R分层的患者中是否具有显著的预后价值,反之亦然。通过采用FAB、WHO 2001和WHO 2008分类,MDS患者被组织成具有内在预后信息的同质类别。然而,虽然形态学分类模型在IPSS-R之外没有显示出预后价值,但IPSS-R在FAB、WHO 2001和WHO 2008分类之外具有显著的预后价值。尽管从预后角度来看,MDS的形态学分类模型可能具有临床相关性,但根据IPSS-R,它们在风险分层方面的相关性显然有限。因此,我们建议在常规临床实践中停止使用MDS的形态学分类模型进行风险分层。